CMS Recovery Audit Prepayment Reviews to Begin Summer 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare & Medicaid Services (CMS) is planning to start the Recovery Audit Prepayment Review (RAPR) Demonstration Project on June 1, 2012. It was originally scheduled to begin January 1, 2012.

Recovery Audit Contractors (RACs) to Review Claims with High Rates of Improper Billing.

The Recovery Audit Prepayment Review allows Recovery Audit Contractors (RACs) to review claims before they are paid. The goal is to ensure that the provider complied with all Medicare payment rules. Prepayment reviews will be conducted on certain types of claims that have been found to result in high rates of improper payments.

Certain States will be the Focus of the Initial Launch of Recovery Audit Prepayment Reviews.

The Recovery Audit Prepayment Reviews will focus on states with high populations of fraud-prone and error-prone providers. These states are California, Florida, Illinois, Louisiana, Michigan, New York, and Texas. The Recovery Audit Prepayment Reviews will also include four states with high claims volumes of short inpatient hospital stays. These states are Missouri, North Carolina, Ohio, and Pennsylvania.

More States May be Included in the Recovery Audit Prepayment Reviews in the Future.

CMS is expecting that the prepayment reviews will help lower error rates by preventing improper payments instead of searching for improper payments after they occur. If these reviews are successful, other states will be included in subsequent stages of the Recovery Audit Prepayment Review Demonstration.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Reimbursement Management Consultants, Inc. “CMS Recovery Audit Prepayment Review Demonstration Project.” Reimbursement Management Consultants, Inc. (Feb. 9, 2012). From: http://rmcinc.org/word/?p=276

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

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One response to “CMS Recovery Audit Prepayment Reviews to Begin Summer 2012

  1. hire ANOTHER UNACCOUNTABLE GOVT CONTRACTOR RATHER THAN REINSTATE LAWS THAT ALLOW FOR CRIMINAL INVESTIGATIONS AND INTERNAL AUDITS OF GOVT CONTRACTORS? sHUTDOWN THE IOLLEGAL OPERATIONS ON-GOING INSIDE THE MEDCIARE AND AMEDIACID CONTRACTORS AND DO SOME REAL AUDITING WHICH HAS NOT OCCURRED SNCE 1994 WHE SEC OF HHS DECIDED THAT THE INS INDUSTYR WOULD BEHAVE AND DIDN;T NEED ANY OVERSITE. I HAVE EVIDENCE OF MAJOR THEFTS AND NOTHING CAN BE DONEEXCPET NOT RENEW THE CONTRACTS WHEN THEY COME UP AND REPLACE THEM WITH OTHER CONTRACTORS SDOING THE SAME THING. this IS JUST MORE WASTE, FRAUD AND ABUSE AS THE CLIAMS PROCESSING COMAPNEIS SHOULDT’ BE USING AN ILLEGAL OFFLINE SYSTEM HIDDEN FROM THE CONTRAT AUDITOS, WHICH IS NO AUDITL ITS JUST REVEWING WHAT THE ONES COMMITTING THEFTS WNAT THEM TO SEE. i RMEMBER THE DAY, WHEN THE GOVT HAD AN ON ISTE REP AT EVERY Medicare/MEDICAID CONTRACTOR TO MAKE SURETHE LAWS, SECURITY AND THE CONSTITUTIONAL RIGHTS OF ALL WERE BEING PHELDAND FRUAD GOT CAUGHT AT VERY LOW LEVESL BEFORE IT BARELY GOT STATRTED. fire goldmine-SACHS AS THE FRAUD REPORT TAKERS AND HIRE SOME REAL FEDERAL EMPLYEES WHO WILL TREAT THE PUBLIC with RESPECT AND DO TRACKING AND CATCH FRAUD EARLY. Tell general dynamics TO LET THIER PEOPLE AT 1-800 MEDCIARE TO AGAIN TAKE FRAUD REPORTS AND SEND THEM DIRET TO cms WEN ITS ABOUT THE GOVT CONTRACTOR BREAKING THE LAW. LINDA JOY ADAMS WITH 17 MEDCIARE NUMBERS CREATED BY THE GOVT CNTRACTORS IN ORDER TO STEAL AND EVEN ONE PAY IS THEFT WHEN NOT CODED A CONDITIONAL PAYMENT. LOOKING FOR FALSE CLAIMS ATTY AS MEDCIARE JUDGES WILLL NOT ENFORCE THE LAWS AS SAY , PATIENT MUST FILE CIVIL SUIT TO RECOVER $4 MILLION STOLEN AND ON-GOING AND US ATTY’S CALL IT A RICCO CASE AS MEDICARE COORDINATNION OF BENEFITS HAD FACILITATED THIS( EMBLEM HEALTH) INSIDERS SAY ITS ABOUT A TRILLION DOLLAR THEFT AND HIRING AOTHER CONTRACTOR TO BE FOOLED DOES NO GOOD. LINDA JOY ADAMS

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